ER Design

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We are experiencing some changes at the ER I work at. I'm just curious to here from some other ER nurses about the set up of your ER.

(Use of Fast Tracks, CDUs, triage process, how you use your techs/aids, ER size, etc.)

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Triage process: we have a greeter (EMT-B) and a lead triage nurse who triage the patients (need to go to a room immediately vs being triaged in the triage area)

Fast-Track: Open 11a-2a; takes low acuity patients

Vertical (similiar to physician office rooms): Open Mon-Thurs, 2p-10p - takes extremely low acuity patients (i.e. medication refills)

CDU: 24 hour observation unit, 15 beds plus a 4 chair infusion area

Currently desigined a geriatric ED area (9 beds), have a pediatric area (open 9a-2a) 12 beds, a trauma/critical care side (open 24/7) and a med/surg/psych/ob side (open 24/7)

Staffing increases at 11a & 2a to accomadate open areas and increase in volume

ED yearly visits: 85,000+

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Specializes in ER, progressive care.

I'm curious to know about other ER designs as we are working on redesigning our own ER. We have already implemented some changes but we're working on more.

Triage: preferably 2 RNs and a triage tech (or two). We have a greeter in the WR and a lead triage nurse. We have tried to implement pull til full in the past but have stopped and now we are trying to do that again...but as of now the lead triage nurse completes the triage in the triage room.

Fast track: open from 1100-2300. Mid-level provider + 2 nurses or 1 nurse + 1 tech. For level 4-5 patients. After 2300 our fast track becomes implemented in our main ER. We have a "results pending" area and a discharge room (where the d/c vitals and instructions are given) that way it keeps the flow going for these patients.

Main ER: includes BH area (locked rooms for our psych holds but we tend to reserve them for our most violent patients), fast track patients integrated into the main ER after 2300 when our FT closes and trauma/critical care beds (open 24/7).

We do not implement the use of hallway beds but I'm interested to hear the experiences of others working in ERs that do implement this practice. How do you comply with HIPAA when you're in an open area with no privacy?

Our ED yearly visits: 60,000+.

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